Researchers: Moriah E. Ellen¹, Einav Horowitz², Raphael Catane³

Background: Significant health resources are consumed inappropriately, and patients can receive unnecessary, ineffective, or potentially harmful care. Oncology is a growing clinical area, in terms of number of patients and costs. Overuse rates in oncology are high, and areas of possible improvement exist for reducing overuse and improving quality of care.

Objectives: The purpose of this study was to explore perceptions and experiences of oncologists in Israel regarding overuse of health services.

Method: In-depth, semi-structured interviews were conducted with four different types of oncologists in Israel. The interview focused on causes of overuse, facilitators for reduction and suggestions for improvement. Interviews were audio-recorded, transcribed, coded, and thematically analyzed.

Findings: Physicians identified causes at the patient, physician and system levels. Patient-level causes included the ‘well-informed’ and ‘demanding’ patient; physician-level causes focused on the need to satisfy patients, and lack of confidence, time, and skills; and system causes focused on ease of access and lack of alignment and coordination. Facilitators for reducing overuse and suggestions for improvement were identified at physician and system levels. Physicians reduce overuse by dialoguing with patients, building trust and solid patient-provider relationships, and can further reduce overuse by teamwork. Regulation of services minimizes overuse on the system level. Further improvements can be made through education, and bottom-up solutions.

Conclusions: Physicians can influence the rate of overuse, as they guide their patients and are part of the system. Future research should incorporate views and perspectives of other stakeholders, and address issues within the broader healthcare system and other clinical specialties.

Recommendations: Interventions are needed at physician and system levels. Initiatives cannot be implemented in an exclusively top-down manner and should include collaborative efforts and shared solutions.
Determining necessary measures requires attention to context and involves everyone from patients to governments.

Research end date: 08/2018